Members of the Norris Cotton Cancer Center, the Dartmouth Medical School, and the Vermont Regional Cancer Center propose to conduct an epidemiologic study of the patterns of lung cancer patient care in New Hampshire and Vermont. The study is designed to determine the nature of geographic variations in care among patients in our rural area and to test whether such differences are related to differences in the local availability of specialized cancer treatment facilities and whether they can account for geographic differences in survival. Using our two-state, population-based tumor registry to identify cases, we will conduct reviews of medical records to determine patient characteristics, functional status, tumor stage, and detailed treatment information. An independent slide review will provide information on tumor histology. We will analyze these data using univariate and multivariate methods to identify the interrelationship of the patterns of treatment with services available and patient survival. The study will allow us to test one of the basic assumptions underlying cancer control programs, i.e., that identifiable populations in the United States lack easy access to sophisticated cancer treatment facilities, and therefore, receive suboptimal care with resultant poor outcome.